CARE OF THE OLDER ADULT 2.

Older adults have no future and

Concepts, Principles and Theories in the therefore health promotion efforts are
Care of Older Adults wasted
Topic Outline 3. Damage to health from poor diet and
Overview inactivity is irreversible
Introduction
History of Gerontological Nursing DEFINITION OF TERMS:
Definition of terms
Aging
OVERVIEW: – refers to the inevitable, irreversible decline in
organ function that occurs over time even in
The objectives of assessing and caring for older the absence of injury, illness, environmental
adults, including effective communication, using risks, or poor lifestyle choices.
Gordon's functional patterns, and promoting – is a development process. It is universal
health. phenomenon with manifestation of increased
Components of assessing older adults, including risk of debility, disease and death.
collecting subjective and objective data through
nursing history, functional assessments, and Ageism
physical exams while considering ethics, – prejudice against people of older age.
communication skills, and the patient's profile. – Based on negative misconception and
stereotypes
Nursing management of older adults focuses on – Leads to discrimination, lower quality care,
supporting cognitive function, promoting safety and preventable illness and disability.
and independence, reducing anxiety, improving – Bias against older people
communication, and addressing social and – Based perception solely on their chronological
nutritional needs. age not on their functional status
– Stereotyping characteristics of elderly
Ex. weal, memory loss, poor, burden,
Introduction: dependent, unreliable, lonely

This introductory chapter recognizes the Gerontology

individuality, uniqueness, and potential for – the study of the aging process including
wellness of every person regardless of age. Brief biologic, sociologic, and psychological changes.
background information is provided that will – Refers to the combined biologic,
orient nursing students to critical issues affecting psychological, and psychological study of older
the present and future of the aged and the adults within their environment
nurse’s role in their care. – Curative aspect

Learning Objectives: Geriatrics

– medical specialty that focuses on treating and
1. Integrate principles and concepts of physical, caring for old people.
social, natural and health sciences and – Branch of medicine that is used to study old
humanities in the care of older adults. age
– Focuses on physiology, pathology, diagnosis,
2. Apply appropriate nursing concepts and and medical management to f the disorders
actions holistically and comprehensively. and diseases of older adults
– Curative aspect
3. Explain major biological, sociological and
psychological theories of aging. Gerontological nursing
– is the specialty of nursing pertaining to older
4. Develop nursing interventions based on the adults.
psychosocial issues and biologic – Field of nursing that specializes in the nursing
changes associated with older adulthood. process
– It includes assessment, nursing diagnosis,
5. Describe characteristics of today’s elderly planning, implementation, and evaluation of
population. older adults
– All nursing settings from acute care,
History of Gerontological Nursing Intermediate, skilled care, extended facilities,
1960s: ANA forms gerontological nursing and also in community
specialty – is a nursing process applied to older adults in
1970s: Veterans Administration (VA) funds all environments, including acute,
Geriatric Research Education and Clinical Centers intermediate, skilled care, and in the
1980s: The National Gerontological Nursing community.
Association (NGNA) established
1990s: Hartford Foundation Institute for Geriatric Senescence
Nursing established at NYU – biological process of aging or the breakdown
21st century: “baby boomers” begin turning 65; of the physical body while growing older.
growing interest in gerontological care
Attitudes towards Aging
Television, Media, Newspapers, Film industry,
Commercials in magazines and on TV,
Greeting card/birthday cards

MYTHS ON AGING
Three major misconceptions about REALITIES OF AGING:
aging 1. Aging is a normal process common
1. Disease in old age is normal
 to all living organisms. age. Aging is the continuum of events that
Every living organism begins aging from occur from conception to death.
the time of conception. The process of  It is a process of becoming older.
aging helps individuals achieve the
mature cellular, organ and system ACQUISITION
functioning necessary for the  Affects one’s capabilities to face
accomplishment of developmental tasks challenges and struggles in life.
throughout life. Every cell of every  Good acquisition in early stage of life
organism ages constantly and is crucial.
continuously.  Usually handed over by parents, but
2. Aging is a life-long process as individual grow she/she now.
Aging is a life-long process that begins at  performs the acquisition alone or
conception. Age related changes are with others.
inevitable. These changes do affect  Environment and relationship with
lifestyle, but most changes can be others shape how one acquires life.
managed in order for the older person to  Obstacles may present itself along
live a happy, productive life. A nurse who the way to test acquisition.
understands that aging is a normal,  positive acquisition
natural process that occurs in all o lightens the burden, resulting
individuals is more prepared to give in successful problem solving
nursing care than the nurse who views and bright achievements.
aging as a disease that must be tolerated. o cheerful disposition
3. Aging is highly individualized  negative acquisition
Aging is highly individualized and o can lead to increased
influenced by factors such as struggles, regrets, and
environment, genetics, health care and dissatisfaction.
health promotion activity. The aging o grumpy, antisocial demeanor
population encompasses those between
65 and 100 plus years. There is great
diversity in years and in mental, physical, LEGACY
and psychological ability. No two older  stage in life where a person has
adults are alike. Nursing care must be achieved self-actualization, radiating
individualized to meet specific individual goodness accumulated over time.
needs.
4. Health habits are reversible  when one has been inspiration for
Disease is not inevitable. In some others and has made a big
instances, the disease is avoidable. Poor contribution to society
health habits are reversible. As the life
span increases, more individuals older LIFE PERSPECTIVE/ GRACEFUL AGING
than 65 are interested in improving the THEORY
quality of life and changing health habits
to provide an even higher quality of life.
 Developed by Sr Lety Kuan
More senior citizens
 Good education is crucial in stablishing
a good legacy.
PERSPECTIVE ON AGING
 Good education is the best we can
-Aging is a gradual, continuous process of natural
give to children.
change that begins in early adulthood. During
 Economic status is not a hindrance to
early middle age, many bodily functions begin to
establish a good legacy.
gradually decline.
 What a child has grown up with (ex:
-People do not become old or elderly at any
presence/absence of affection,
specific age. Traditionally, age 65 has been
attention, etc) is what he/she will
designated as the beginning of old age. But
bring up it to adulthood
the reason was based in history, not biology.
 Honesty and love are what matters in
Many years ago, age 65 was chosen as the age
the upbringing of a person
for retirement in Germany, the first nation to
 Regardless of religion, as long as one is
establish a retirement program. In 1965 in the
spiritual, one cannot be cruel or selfish
United States, age 65 was designated as the
(sharing is a key factor)
eligibility age for Medicare insurance. This age is
 In terms of dealing with people without good
close to the actual retirement age of most people
acquisition, it is the therapeutic role of a
in economically advanced societies.
nurse/caretaker to let them acquire what
they missed early in life.
AGING IS A DEVELOPMENTAL PROCESS
 One must reflect the things
Sr Lety Kuan views life as a 3-pronged
they missed in the past in order
course
to help them acquire it.
3 components of life course:
 What the person lacks, the
1. Acquisition
nurse must fill in
2. Struggle
3. Legacy
Development Principles
Components are the sum of experiences an
1. Development is lifelong.
individual has gathered throughout existence
2. Development depends on history and context.
(positive and negative)
3. Development is multidimensional and
multidirectional and involves a balance of growth
 Continuous process that starts from and decline.
conception up to old age 4. Development is plastic rather than rigid.

Despite the normality and naturalness of this

experience, many people approach aging as
 Aging is a natural process. Constantly and though it were a pathologic experience,
continuously, every cell of every organism witnessed by comments that associate aging
with: begin to function less effectively, making
us more vulnerable to disease
“looking gray and wrinkled”
“losing one’s mind”
“becoming sick and frail” 1. Chronological age - measured by the number
“obtaining little satisfaction from life” of years lived.
“returning to childlike behavior”
“being useless” 2. Biological age - predicted by the person’s
physical condition and how well vital organ
Ageism - negative attitude towards aging and systems are functioning.
older adults.
3. Psychological age- expressed through a
TYPES OF AGING person’s ability and control of memory, learning
When a person becomes old can be answered in capacity, skills, emotions and judgement.
different ways:
 Chronologic age is based solely on the 4. Social age - measured by age - graded
passage of time. It is a person’s age in behavior that conform to an expected status
years. Chronologic age has limited and role within a culture or society.
significance in terms of health.
Nonetheless, the likelihood of developing STAGES OF OLDER ADULTS / SUBSETS OF
a health problem increases as people age, ELDERLY
and it is health problems, rather than Gerontology is the study of aging and the
normal aging, that are the primary cause aged.
of functional loss during old age. Because 1. Geriatrics- medical care of the aged.
chronologic age helps predict many health 2. Social Gerontology- focuses on social
problems, it has some legal and financial aspects of aging.
uses. 3. Geropsychology- seeks to address the
 Biologic age refers to changes in the concerns of older adults.
body that commonly occur as people age. 4. Geropharmacology- study of pharmacology
Because these changes affect some in relation to older adults.
people sooner than others, some people 5. Financial Gerontology- combines knowledge
are biologically old at 65, and others not of financial planning and services with special
until a decade or more later. However, expertise in the needs of older adults.
most noticeable differences in apparent 6. Gerontological Rehabilitation Nursing -
age among people of similar chronologic combines expertise in gerontological nursing with
age are caused by lifestyle, habit, and rehabilitation concepts and practice.
subtle effects of disease rather than by 7. Gerontological Nursing - nurses advocating
differences in actual aging. for the health of older persons at all levels of
 Psychologic age is based on how people prevention.
act and feel. For example, an 80-year-old
who works, plans, looks forward to future DEMOGRAPHICS OF AGING AND
events, and participates in many activities IMPLICATION TO HEALTH AND NURSING
is considered psychologically younger. CARE

Most healthy and active people do not need the DEMOGRAPHICS- Study of population based on
expertise of a geriatrician (a doctor who factors such as age, race and sex.
specializes in the care of older people) until they
are 70, 75, or even 80 years old. However, some The aging of the population affects the demand
people need to see a geriatrician at a younger for all health care services, including hospitals,
chronologic age because of their medical and long-term care.
conditions.
● Gerontology is the study of the aging Older persons use more health services
process, including physical, mental, and than their younger counterparts because
social changes. The information is used to they have more health problems.
develop strategies and programs for
improving the lives of older people. Some They are also hospitalized more often and have
gerontologists have a medical degree and longer lengths of stay than younger persons.
are also geriatricians. Elderly is small due to the high fertility rate. Life
expectancy averages 63.5 years.

What is the present Demography of Aging in

the Philippines?
● Geriatrics is the branch of medicine that
specializes in the care of older people, Aging in the Philippines
which often involves managing many
disorders and problems at the same time. • The country consists of approximately 103
Geriatricians have studied the aging million inhabitants, with less than 5% of the
process so that they can better distinguish population 65 years and older.
which changes result from aging itself and • Currently, the age structure of the
which indicate a disorder. Philippines resembles many other
● Some bioethicists argue that aging is, in developing countries because there is a
fact, a natural developmental process for greater proportion of younger Filipinos in
human beings (Meilaender, 2011). comparison to older Filipinos.
According to Meilaender (2011), aging is a • Despite the larger number of young
normal stage of life in which our bodies Filipinos, the 60 years and older population
of the Philippines is expected to increase by
 4%, whereas the 80 years and older anticipatory grief and fear of financial
population is expected to increase by 0% strain."
from 2010 to 2030. The Philippines’s FINANCIAL EFFECTS
population increased by over 35% over the -Caring for aging parents often means extra costs
last two decades with the older adult related to home health care, medical expenses
population expected to overtake those aged not covered by insurance and extra insurance
0– 14 years old by 2065. premiums for services such as long-term care.
• Currently, life expectancy of Filipinos is 57 You also may need to take off extra time from
years for males and 63 years for females. work.
Females are projected to expect an increase STRUCTURAL EFFECTS
of 4 years in life expectancy and males an -When you live with your aging parents or
increase of 4 years in life expectancy by assume a high amount of daily care for them, you
2030 experience a change in your family roles. Thomas
and Segur describe this as a "shift in family
GLOBAL AGING structure and hierarchy related to the matriarch
 United Nations (2020) or patriarch no longer being in their role." When
this occurs, "someone new has to take their
 Global population aged 60 years old place."
and above accounts to 962 million
 In USA, around 53.7 million aging
population HEALTH STATUS OF OLDER ADULTS

 Since the beginning of recorded history,  The older population experiences

young children have outnumbered their fewer acute illnesses than younger
elders. In about five years’ time however, age groups and a lower deathrate
the number of people aged 65 or older will from these problems. However, older
outnumber children under age 5. Driven by people who do develop acute
falling fertility rates and remarkable illnesses usually require longer
increases in life expectancy, population periods of recovery and have more
aging will continue, even accelerate complications from these conditions.
 In 2010, an estimated 524 million people  Chronic illness is a major problem for
were aged 65 years and older– 8 percent of the older population. Most of the
the population. By 2050, this number is older adults have at least one
expected to nearly triple to about 1.5 billion, chronic disease, and typically, they
representing 16 percent of the world’s have multiple chronic conditions,
population. Although more developed termed comorbidity.
countries have the oldest population  Chronic conditions result in some
profiles, the vast majority of the older limitations in activities of daily living
people—and the most rapidly aging and instrumental activities of daily
populations—are in less developed living for many individuals. The older
countries. Between 2010 and 2050, the the person is, the greater the
number of older people in less developed likelihood of difficulty with self-care
countries is projected to increase more than activities and independent living.
250 percent, compared with a 71 percent
increase in developed countries.

AGING SOCIETY

- the societal aspect of aging is marked by the

IMPACT OF AGING MEMBERS IN THE FAMILY rapidly growing number and proportion of older
“Aging can contribute poor family people in the population.
relationship in a number of ways.”
-Caring for aging parents as well as to any aging A. Industrialization
beloved family members has multiple impacts on - It is most difficult for the older worker
your family life, including emotional, physical, who becomes unemployed to find a
financial and structural effects. As you and your new job.
family make plans and you reflect on your future B. Urbanization
as a caregiver, take time to appreciate the - The small dwelling units’
strength you derive from working together and characteristics of urban life and of
the unique bonds you share as family. shrinking two generation family make
it difficult or impossible for
EMOTIONAL EFFECT grandparents to live with their children
-Caring for your aging parents prompts a range of and this complicates the problem of
impulses and emotions. Katie Thomas and older people in finding living
Mishelle Segur, co-owners and directors of Hearts arrangements that satisfy their needs.
and Hands Counseling, say that common C. Lack of Facilities for Older People
responses include "Guilt for not being able to - There are few opportunities for older
do more for parents; anger for having to set people to find the health services they
aside your own needs or shift your need, make new friends, learn and
priorities; and fear and anxiety, including practice creative activities, retrain for
 new jobs, seek recreation, and take good care of the rapidly increasing
participate in educational and number of the aged.
community experiences.
Aging
EFFECTS ON SOCIETY - defined as the time-related deterioration
- The effect of aging on the economy is of the physiological functions necessary
fundamental. for survival and fertility.
- The growing number of older people can - OR Aging process is the process of
become financial dependents. growing old or developing the appearance
- Older people derive their incomes from gainful and characteristics of old age.
employment, work-connected pensions, savings,
help from relatives, and through government in Each theory of aging attempts to provide a
the form of different payments or services in kind framework in which to understand aging from
different perspectives.
A. Employment
Importance of employment for older people: It is useful to the clinician because a framework
o It satisfies the needs of many for and insight into differences among elderly
financial security and the feeling of patients are provided.
usefulness.
o It maintains their status as income The theories of aging are classified into:
producers rather than financial
dependents. 1. Biological Theory:
o It takes advantage of their capacities - Biologic theories of aging attempt to
as producers of goods and services explain why the physical changes of aging
occur. Researcher try to identify which
Older workers are not hired because of: biologic factor have the greatest influence
o slowing down on longevity.
o deterioration - It is divided into following types-
o resistance to new processes A. The programmed theory/ Biological clock
o susceptibility to injury theory
B. The run out of program theory
Retirement is a major adjustment of an aging C. Gene theory
individual. This transition brings the loss of a work D. Molecular theory
role and is often an individual’s first experience of E. Cellular theories
the impact of aging. In addition, retirement can Biological Theories
require adjusting to a reduced income and • Programmed theory/ Biological clock theory
consequent changes in lifestyle. • Run out of program theory
• Gene theory
“Abrupt retirement is a death sentence to large • Molecular theory
numbers of old people, and a sick or morale • Cellular theories
breakdown to many others.” • Error theory
• Somatic mutation theory
B. Living Arrangements • Free radical theory
The well-being of the individual at any age • Clinker theory
depends upon his ability to satisfy his total needs • Wear and tear theory Biological Theories
in socially acceptable ways. Basic needs do not
change with age, although the means of
satisfying them may.
Programmed theory/Biological clock
theory:

Most of the older people seem to wish to live in - The programmed theory proposes that
their own homes to enjoy continued status of every person has a “Biologic clock” that
independence, self-management and privacy, starts ticking at the time of conception.
feeling of emotional security derived from familiar - In this theory each individual has a
surroundings. genetic program specifying an unknown
but predetermined number of cell
It is natural that they should like to be near long- divisions.
time friends, near children if possible, and near - As the program plays out, the person
shopping centers and familiar institutions. experiences predictable changes such as
atrophy of the thymus, menopause, and
For many older people, the home should be on skin changes and graying of the hair.
one floor and should be as free as possible from - Aging has a biological timetable or internal
health hazards. biological clock.

2. Cellular theories:
THEORIES OF AGING
- The cellular theories propose that aging
Geriatric nursing
is a process that occurs because of cell
- is the specialty that concerns itself with
damage. When enough cells are damaged,
the provision of nursing services to overall functioning of the body is
geriatric or aged individuals. decreased.
- Due to their complexity, aged people - The free radical theory
always deserve personal attention.
- The crosslink or connective tissue theory
- Nurses address physical, psycho social,
- Clinker theory
cultural and family concerns as well as
- The wear and tear theory
promoting health and emphasizing
successful aging.
- Life expectancy is rising at rates which call 3. Psychosocial Theory
for the proper preparation of nurses to
 - Psychosocial theories of aging attempt to point they realize there are many things
explain changes in behavior, roles and they have not done.
relationship that occur as individual age. - At this age they begin to question whether
- This attempt to predict and explain the the decision and choices they have made
social interactions and roles that were the right choices for them.
contribute to successful adjustment to old - This is so called “midlife crisis”, which
age in older adults. can lead to radical career or lifestyle
1. The disengagement theory changes or acceptance of the self as is.
2. The activity theory - As aging continues, Jung proposes that the
3. The continuity theory individual is likely to shift from an outward
4. The subculture theory focus (wit concerns about success and
social position) to a more inward focus.
Development Theories - Successful aging includes acceptance and
- Developmental theories or life-course valuing of the self without regard to the
theories. view of others.
- These theories trace personality and
personal adjustment throughout a Havighurst’s Theory:
person’s life. - Havighurst’s (1968) theory details the
- Many of these theories are specific in process of aging and defines specific task
identifying life- oriented tasks for the for late life, including:
aging person.  Adjusting to decreased physical strength
- It is of following types: and health,
 Erikson’s Theory  Adjusting to retirement and decreased
 Havighurst’s Theory income,
 Newman’s Theory  Adjusting to the loss of a spouse,
 Peck’s Theory  Establishing a relationship with one’s age
 Jung’s theory group,
 Adapting to social roles in a flexible way,
Erickson’s Theory and
 Establishing satisfactory living
Erickson’s (1963) theory identifies eight stages arrangements.
of developmental tasks that an individual must - Later maturity is Havighurst’s term for
comfort throughout the life span: older adults.
 Trust versus mistrust - The task for later maturity is
 Autonomy versus shame and doubt disengagement.
 Initiative versus guilt - Disengagement from tasks of middle age
 Industry versus inferiority allows involvement in new roles such as
 Identity versus identity confusion grandparent, citizen, and friend.
 Intimacy versus isolation
 Generativity versus stagnation
 Integrity versus despair

- The last of these stages is the domain of

late adulthood, but failure to achieve
success in tasks earlier in life can cause
problems later in life.

Newman’s theory
- The stage pertaining to older adults is: - theory identifies the task of aging as
Ego integrity versus Despair. coping with the physical changes of aging,
- The task of this stage is acceptance of redirecting energy to new activities and
one’s life as meaningful and that death is roles including retirement, grand
part of life, versus despair, which is failure parenting and widowhood accepting one’s
to accept the meaningfulness of one’s life, own life; and developing a point of view
along with fear of death. about death.

Peck Theory:
- Peck expanded Erikson’s theory and
focused more on later
developmental stages.
- Body transcendence versus body
preoccupation is a phase concerned with
enjoyment of life in the face of physical
discomforts associated with aging.
- Ego transcendence versus ego
preoccupation is a phase concerned with
the older adult’s ability to focus on the
welfare of the future generation rather
than on one’s own inevitable death.

Jung’s theory:
- Jung’s theory proposes that the
development continues throughout life by
a process of searching, questioning and
setting goals that are consistent with the
individual’s personality.
- As individuals age, they go through a
reevaluation stage at midlife, at which